El Beitune Patrícia, Duarte Geraldo, Foss Milton César, Montenegro Renan Magalhães, Spara Patricia, Quintana Silvana Maria, Figueiró-Filho Ernesto Antonio, da Costa Antonio Gadelha, Filho Francisco Mauad
Department of Obstetrics and Gynecology, Medicine School of Ribeirão Preto, University of São Paulo, Brazil.
Diabetes Metab Res Rev. 2006 Jan-Feb;22(1):59-63. doi: 10.1002/dmrr.576.
Despite the correlation between the use of protease inhibitors (PI) and adverse metabolic glycemic events, no prospective study has examined these parameters in pregnant women who use these drugs.
A prospective study was conducted on 57 pregnant women to investigate the effect of antiretroviral drugs (ARV) on the carbohydrate metabolism during pregnancy. The women were divided into three groups: ZDV Group, 20 HIV-1 infected women taking ZDV; TT Group, 25 patients on triple antiretroviral treatment (ZDV + 3TC + NFV); and Control Group, 12 pregnant women. Blood samples were obtained during the first visit for the determination of fasting plasma glycemia, when the patients were also submitted to a 75 g oral glucose test (OGTT-75g). These procedures were performed four times along pregnancy.
The median values of the area under the glycemia curve (AUC) determined over a period of 120 min between the 33rd and 38th week were 11 685 mg/dL for the Control Group, 13 477 mg/dL for the ZDV Group, and 13 650 mg/dL for the TT Group (p = 0.049). There was an increase in the AUC along pregnancy for all three groups studied, regardless of the treatment used, although this increase was significant only in the TT Group (p = 0.001). The antiretroviral agents had no deleterious effects on prematurity, low birth weight, intrauterine growth restriction rates, or on Apgar score.
An association was detected between the use of PI and the development of carbohydrate intolerance during pregnancy. The antiretroviral agents had no deleterious effects on perinatal prognosis.
尽管蛋白酶抑制剂（PI）的使用与不良代谢性血糖事件之间存在关联，但尚无前瞻性研究在使用这些药物的孕妇中检测这些参数。
对57名孕妇进行了一项前瞻性研究，以调查抗逆转录病毒药物（ARV）对孕期碳水化合物代谢的影响。这些妇女被分为三组：齐多夫定（ZDV）组，20名感染HIV-1的妇女服用ZDV；三联疗法（TT）组，25名接受三联抗逆转录病毒治疗（ZDV + 拉米夫定 + 奈非那韦）的患者；以及对照组，12名孕妇。在首次就诊时采集血样以测定空腹血糖，此时患者还需接受75克口服葡萄糖耐量试验（OGTT-75g）。这些检查在孕期进行了四次。
在第33至38周期间120分钟内测定的血糖曲线下面积（AUC）的中位数，对照组为11685毫克/分升，ZDV组为13477毫克/分升，TT组为13650毫克/分升（p = 0.049）。在所研究的所有三组中，无论使用何种治疗方法，AUC在孕期均有所增加，尽管这种增加仅在TT组中具有统计学意义（p = 0.001）。抗逆转录病毒药物对早产、低出生体重、宫内生长受限率或阿氏评分均无有害影响。
检测到PI的使用与孕期碳水化合物不耐受的发生之间存在关联。抗逆转录病毒药物对围产期预后无有害影响。
